The epidemiology of brain death in Tuscany: is there need for novel indicators?

Quality monitoring of the donation process requires appropriate indicators. We performed a retrospective review of all patients with encephalic lesions (ELs) reported to the Tuscany Quality Program of Donation during 2003 to 2007, seeking to assess whether there were differences in the brain-death-to-patients-with-encephalic-lesions (BD/EL) ratio, which is a current indicator of the efficiency of the donation process. The theoretical framework was that the type of disease may influence the probability of BD, and the subsequent donation process. During the study period 2555 patients were reported to display ELs. The overall BD/EL ratio was 48.1%, that is, 1229 patients were reported to be BD donors to the regional coordinating center at a later time point during patient hospitalization. With regard to the etiology, 1374 (53.8%) patients suffered cerebrovascular (CV disease); 514 (20.1%) traumatic (T); 397 (15.5%) postanoxic (PA); 55 (2.1%) neurological neoplasms (NN); and 215 (8.4%) other diseases (O). The BD/EL ratio by disease type was 57.2% for CV (786/1374); 58% for T (298/514); 19.4% for PA (77/397); 36.4% for NN (20/55); and 22.3% for O subjects (48/215). Despite its limitations, the current analysis advocates stratification of deceased donors by type of disease to allow better understanding and monitoring of the donation process.